Lancashire Teaching Hospitals NHS Foundation Trust

3. Mrs F complains the Trust focused on the possibility of a recurrence of Mr F’s previous cancer and failed to adequately investigate the cause of his symptoms in April 2024.

4. Mrs F says if the Trust had diagnosed her husband with cancer sooner, he could have received treatment which may have extended his life.

5. Mrs F would like the Trust to make service improvements.

6. Mr F was in his mid-fifties at the time of the events Mrs F complains about. We understand he was diagnosed with cancer of the left tonsil in May 2020 and underwent radiotherapy and chemotherapy treatment that year. The treatment was successful and between December 2020 and November 2023, Mr F had regular reviews which found no evidence of a recurrence of the cancer.

7. On 22 March 2024, Mr F went to his GP with difficulty swallowing and earache. The GP asked the Trust to bring Mr F’s regular review appointment forward.

8. Mr F had an appointment on 2 April, followed by an ultrasound of his neck on 17 April. The Trust advised Mr F it had not found any signs that his cancer had come back. It arranged to see him in the clinic at his regular review appointment in October 2024.

9. Mrs F explained Mr F’s symptoms of earache and difficulty swallowing got worse between May and June. She told us he also started to experience indigestion. From the end of June onwards, we understand Mr F saw several specialists, including a private ear, nose, and throat (ENT) doctor. The ENT doctor arranged for Mr F to have an MRI scan on 30 July.

10. Unfortunately, Mr F’s scan showed a suspected tumour in his oesophagus. This was confirmed by the Trust’s multidisciplinary team (MDT) to be oesophageal cancer on 13 August and at this point, the MDT decided the tumour was unfortunately too advanced to be removed. The Trust planned to treat Mr F with palliative chemotherapy or immunotherapy.

11. On 25 August, Mrs F took Mr F to the Trust’s Emergency Department (ED) because he was struggling to breathe. Shortly after this, Mr F had a seizure and lost consciousness. He sadly died within a few hours.

Recurrence of tonsil cancer

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that anything has gone wrong.

16. The JLO guideline on follow-up treatment for head and neck cancers states that the purpose of follow-up care is for the early identification of a recurrence, the early detection of new primary tumours, and the monitoring and management of any complications.

17. The guideline says patients should be clinically assessed at their follow-up appointments, and this clinical assessment should include a nasopharyngolaryngoscopy. This is a medical procedure where a thin, flexible fibreoptic tube with a camera (called an endoscope) is used to look at the nasal passages, the area behind the nose, the throat, and the voice box.

18. The records show at his appointment on 22 March, Mr F told the GP he had been experiencing throat and neck discomfort for about four weeks when he coughed. He reported his speech and swallowing were not affected, and he had not lost any weight. He also reported a lump on his neck. As we know, the GP booked an ultrasound for Mr F and arranged for his regular review appointment at the Trust to be brought forward.

19. We understand from our adviser that given Mr F’s previous diagnosis, it was reasonable for the ENT consultant to examine him with a particular focus on excluding the possibility that the tonsil cancer had returned.

20. We can see from the records the ENT consultant also assessed the symptoms Mr F was experiencing at the time. Our adviser said the records show the ENT consultant did not limit their examinations only to the site of Mr F’s previous tonsil cancer. They said the records show the ENT consultant also examined Mr F’s throat and neck.

21. The records from Mr F’s appointment with the Trust on 2 April show he told the ENT consultant about the lump and described discomfort on the right side of his neck when coughing. We can see the ENT consultant examined Mr F and recorded that his lymph nodes were not swollen. Swollen lymph nodes can indicate an infection or the presence of cancer.

22. We can also see the ENT consultant performed a nasopharyngolaryngoscopy, examining Mr F’s mouth, nose, the area behind his nose, his voice box, and his throat. He recorded that everything appeared normal, with no signs that his tonsil cancer had returned. The ENT consultant also noted there was no sign of any abnormality that would warrant further investigation.

23. As we know, Mr F had an ultrasound on 17 April. This showed that his thyroid and salivary glands appeared normal, and his lymph nodes were not swollen. The ENT consultant advised Mr F that the result of the ultrasound was consistent with his examination earlier in April.

24. Based on the evidence available, we do not see an indication the Trust only considered Mr F’s previous cancer when it assessed him in April, or that it departed from the JLO guideline by focusing on his previous diagnosis. We recognise that Mr F was later diagnosed with oesophageal cancer and that, with hindsight, Mrs F understandably feels the Trust should have identified this sooner. We do not think the fact that Mr F was later found to have oesophageal cancer means something went wrong when the Trust assessed him in April.

Failure to investigate the possible cause of Mr F’s symptoms

25. The NICE guideline on the recognition and referral on suspected cancer sets out the signs and symptoms that ‘warrant investigation’. The guideline recommends any patient with dysphagia (difficulty or discomfort when swallowing) should be referred on a suspected oesophageal pathway. It also recommends referral for patients aged 55 or over who have weight loss together with upper abdominal pain, reflux or dyspepsia (heartburn like symptoms).

26. We cannot see evidence that Mr F reported dysphagia or weight loss when he saw the GP in March and the Trust in April. Our adviser said Mr F did not appear to report symptoms that would have warranted investigation for oesophageal cancer. They said the investigations the Trust undertook were appropriate for the symptoms he reported at the time.

27. Based on what we have seen, we do not see indications the Trust departed from the NICE guideline on the recognition and referral of suspected oesophageal cancer.

28. We fully empathise with how Mrs F’s life has been affected by Mr F’s rapid deterioration and sad death. We can see how much work she has put into understanding what happened and raising her complaint. We hope our statement clearly explains the reason why we cannot consider the complaint further.

1. We thank Mrs F for her complaint about the care the Trust provided her husband, Mr F. We offer our sincere condolences to Mrs F for her sad loss.

2. We have carefully considered Mrs F’s complaint. We think the Trust acted in line with relevant guidance when it assessed and examined Mr F in April 2024. As we have not seen any indications of failings, we have decided not to consider Mrs F’s complaint further.